Global burden of oropharyngeal cancer attributable to human papillomavirus by anatomical subsite and geographic region

BackgroundOropharynx is the anatomical site with the highest human papillomavirus (HPV) infection in head and neck. Many studies on HPV prevalence and p16^INK4a positivity in oropharyngeal cancer have been published in recent years. We aimed to update the global burden estimates of oropharyngeal cancer attributable to HPV with the latest data and estimate global burden of tonsillar cancer and base of tongue cancer attributable to HPV by region and country.MethodsWe calculated the number of new cancer cases using the Cancer Incidence in Five Continents Volume XI (CI5XI) and country-specific population in 2012 issued by the United Nations. Estimates of HPV prevalence and p16^INK4a positivity were obtained from literature search and pooled analyses where necessary.ResultsGlobally the number of oropharyngeal cancer and tonsillar cancer attributable to HPV were 42,000 and 20,000 in 2012, corresponding to AFs of 42.7% and 52.7%. The number of cancer cases attributable to HPV among males was about 4-fold greater than that among females. For both oropharyngeal cancer and tonsillar cancer, AFs were higher in more developed countries. Among HPV positive oropharyngeal cancer cases, 86.7%, 87.8%, and 92.5% could have been prevented by bivalent (2v), quadrivalent (4v), and nonavalent (9v) HPV vaccines.ConclusionsIt is worth considering the inclusion of HPV immunization in males, especially in the regions where oropharyngeal cancer is highly prevalent.     

Microarray analysis of tonsils in immunoglobulin A nephropathy patients

Background

Recently, combination of tonsillectomy and steroid pulse therapy was reported to be effective as the treatment of the immunoglobulin A nephropathy (IgAN). However, the gene expression difference between the tonsils in patients with IgAN and those in control patients is not established.

Methods

We performed tonsillectomy combined with steroid pulse as a treatment to IgAN, analyzed the gene expression in the tonsils (N = 23) using microarray, compared with those with patients suffering from chronic tonsillitis (N = 22). From some candidate genes related with IgAN, we confirmed the apolipoprotein B messenger RNA-editing enzyme catalytic polypeptides 2 (APOBEC2) gene expression in the tonsil and we also analyzed its expression levels and clinical features.

Results

Up-regulated genes seem to be categorized into two groups. One group belongs to the muscle related genes which might be caused by structural differences. The other group includes the immune system-related genes, such as APOBEC2, CALB2, DUSP27, and CXCL11. APOBEC2 was positively stained in the epithelium and the peripheral region of the germinal center in both tonsils. APOBEC2 expression level was negatively related with serum igg level, but did not correlate with clinical course after tonsillectomy.

Conclusion

We confirmed gene expression differences related with immune system and muscle structure. The APOBEC2 was confirmed to be elevated in the tonsils with IgAN patients, and the gene expression level was negatively related with serum igg level in overall patients. These results might be helpful to reveal the mechanism of IgAN.     

Should Deceased Donors be Tested for vCJD?

The 1997 Bovine Spongiform Encephalopathy enquiry and the 2001 Hepatitis C litigation judgement set the UK scene for evoking the precautionary principle and the legal precedent that liability for defective transfusion products should not be dependent on medical negligence, but on the mere fact of defectiveness. Animal models indicate that vCJD in humans, with infection via the oral route, is likely to be associated with infectivity within the lymphoreticular system (LRS). This is likely to appear prior to the involvement of the central nervous system and thus infectivity is likely to be present in the LRS before the onset of clinical disease. A number of relevant epidemiological studies using LRS tissue have shown a low, but measurable, existence of the carrier state in vCJD. Two possible cases of transmission of the abnormal prion of vCJD by blood transfusion suggested that tissues might also transmit and that testing of LRS tissue from deceased potential tissue donors should be considered as a first measure towards the prevention of vCJD transmission by tissues designated for use in transplantation. A variety of different tissues could be used as representative of the LRS, but each is associated with problems of feasibility and practicality. Assays for vCJD have not been validated in the context of donor screening rather than epidemiological studies nor on deceased donors. However, given the number of vCJD cases in the UK, significant attention should be paid to the logistical, ethical, social and other issues associated with undertaking vCJD testing of tissue donors, with a view to introducing testing of deceased tissue donors for vCJD disease or latency.     

人体正常扁桃体和淋巴结T、B淋巴细胞亚群的研究

本文用了一系列T、B淋巴细胞单抗,用免疫细胞化学技术观察了人淋巴结和扁桃体内T,B淋巴细胞及其亚群。T细胞及其亚群主要位于滤泡间的副皮质。此外在淋巴结髓质也有一定数量的T细胞亚群的分布;次级滤泡生发中心也常出现辅助T或Leu 4阳性T细胞。B淋巴细胞及其亚群多集中在初级和次级滤泡,如OKB_2和BA 1阳性细胞多集中于次级滤泡的帽状区,而IgM主要位于次级滤泡的生发中心。LN-2抗体选择性地与生发中心??和帽状区的B细胞的核膜起反应,是研究B细胞表型的一种重要试剂。     

Value of intraoperative ultrasonography in tonsil cancer

Background

The exact assessment of a tonsil carcinoma''s size is often difficult because of the tumour''s submucosal extension and deep infiltration.

Aim

The aim of the study is to assess the usefulness of intraoperative ultrasonography in tonsil cancer.

Material

Twenty patients with carcinoma of the tonsil were included in the study (squamous cell carcinoma keratosis – 12, squamous cell carcinoma akeratosis – 6, diffuse large B cell lymphoma – 1, neoplasma malignum microcellulare – 1).

Method

Transcutaneous, endoscopic, and intraoperative ultrasonography were performed using a linear 7.5 MHz probe.

Results

The difference in the results was statistically significant between palpation examination and intraoperative ultrasonographic examination, between transcutaneous ultrasonographic examination and intraoperative ultrasonographic examination, and between endoscopic ultrasonographic examination and intraoperative ultrasonographic examination in tonsil tumours. Generally, tumour size assessed by intraoperative ultrasonography was more advanced than those assessed by other methods.

Conclusions

Intraoperative ultrasonography is a safe, non-invasive method, which can be repeated at every stage of surgery. There were no contraindications or side effects. In all cases histological margins corresponded to sonographic margins. Intraoperative ultrasonography provides a quick and reliable orientation during resection of tonsil carcinoma.     

Dark and light zones of germinal centres of the human tonsil: an ultrastructural study with emphasis on heterogeneity of follicular dendritic cells

Summary The cellular composition of the dark and light zones of germinal centres in human tonsils was quantitatively determined by electron microscopy. In addition to the well known germinal-centre B-cells, we defined the cleaved blast as a new distinct cell type in the germinal centre. The dark and the light zones clearly differed in their content of lymphoid and non-lymphoid germinal-centre cells. The dark zone was characterized by higher frequencies of cleaved blasts and small centroblasts, a higher blast-centrocyte ratio and a higher incidence of mitotic figures. In contrast, the light zone had higher frequencies of centrocytes, centroplasmacytoid cells, lymphocytes and follicular dendritic cells (FDC) and an inverted blast-centrocyte ratio. Seven distinct appearances of FDC (FDC.1-FDC.7) could be recognized on the basis of their ultrastructure. The distribution pattern of these subtypes differed between the dark and light zone. The undifferentiated subtypes FDC.2 and FDC.3 predominated in the dark zone. In contrast, the highly differentiated subtypes FDC.4 and FDC.5 were present at a much higher density in the light zone. These findings suggest that the dark and light zones are different compartments with regard to proliferation and differentiation of germinal-centre B-cells and that both compartments have a specific microenvironment influenced by FDC.     

483例儿童扁桃体腺样体肥大分离菌的分布和药敏特征

目的:分析儿童手术切除的扁桃体腺样体分离菌的分布及药敏特征,为其临床预防和治疗提供指导。方法:将483例扁桃体腺样体进行细菌培养,分析潜在致病菌组成及其药敏特征。结果:扁桃体和腺样体的细菌培养阳性率分别为66.43%和52.88%,主要病原菌及其分离率分别为金黄色葡萄球菌(20.71%)、流感嗜血杆菌(15.11%)、肺炎链球菌(10.97%)、A群链球菌(6.42%),金黄色葡萄球菌对青霉素的耐药率达82%,21%菌株为MRSA,流感嗜血杆菌β-内酰酶检测阳性率为30.92%,复方新诺明和氨苄西林耐药率较高,分别为50.69%和30.14%,肺炎链球菌对青霉素耐药率为32.08%,红霉素、四环素、复方新诺明耐药率高,分别为81.13%、79.25%和69.81%,A群链球菌对青霉素仍然100%敏感,红霉素、克林霉素、四环素的耐药率高,分别为83.87%、77.42%、58.06%。结论:扁桃体和腺样体主要分离菌有金黄色葡萄球菌、流感嗜血杆菌、肺炎链球菌、A群链球菌,不同检出菌的耐药性差异明显,临床可根据常见检出分离菌的分布及药敏特征预防和治疗感染。     

Critical review on the efficacy and safety of levobupivacaine peritonsillar infiltration

Levobupivacaine is a long-acting local anesthetic that is both safe and non-toxic. However, few researchers have examined the efficacy and safety of peritonsillar injections of levobupivacaine for postoperative pain relief. The goal of this study was to assess current randomized controlled trials that employed this strategy. A literature review was conducted using databases such as DELPHIS, PUBMED, COCHRANE, and SCOPUS. A total of fifteen randomized controlled trials were found and thoroughly reviewed. There were no fatalities reported. One study reported a case of nausea and vomiting. In most of the studies, levobupivacaine with magnesium, epinephrine, dexamethasone hydrochloride, tramadol, or levobupivacaine alone were compared to a placebo. Four trials employed different combinations of levobupivacaine and other medicines to recruit adults. Most of the studies had a modest sample size. As a result, larger research with more representative populations should be conducted. Despite certain flaws in the trial design, our findings suggest that levobupivacaine is safe and effective at reducing postoperative pain.     

A simplified method for detecting pathogenic Yersinia enterocolitica in slaughtered pig tonsils

The aim of this study was to collect preliminary data on the carriage of pathogenic Yersinia enterocolitica in slaughtered pigs in France and to test a simplified method for detecting these strains from tonsils. From January to March 2009, 900 tonsil swabs were taken from pigs at one slaughterhouse in Brittany, France. The swabs were vortexed in 10 ml PSB broth, then 1 ml was added to 9 ml ITC broth. The media were incubated for 48 h at 25 °C. The PSB enrichment broth was streaked on CIN plates and the ITC enrichment broth on SSDC plates. In addition to the ISO 10273 method, we also streaked ITC enrichment broth on CIN plates. The plates were incubated for 24 h at 30 °C, and we then streaked a maximum of four typical colonies per plate onto a plate containing chromogenic medium (YeCM), for the isolation of pathogenic Y. enterocolitica isolates. In parallel, biochemical assays were carried out to confirm the identification of the isolates as Yersinia and to determine biotype.After passage on a YeCM plate and biochemical tests, 380 strains were confirmed to be pathogenic Y. enterocolitica. Finally, with the ISO 10273 method, 9.1% (CI_95% [5.8-12.4]) of tonsil swabs and 60% (CI_95% [45.4-74.6]) of the batches were positive. With the ITC-CIN method, 14.0% (CI_95% [10.7-17.3]) of the tonsil swabs and 68.9% (CI_95% [54.3-83.5]) of the batches were positive. Identification as pathogenic Y. enterocolitica was confirmed for 97.0% of the typical colonies obtained on the chromogenic medium, YeCM. The most prevalent biotype was biotype 4 (80.5% of the isolates), followed by biotype 3.This study demonstrates that the ITC-CIN method, followed by streaking on YeCM, may be an effective approach to the isolation of pathogenic Y. enterocolitica from tonsil swabs and the recovery of positive samples. This method is less time-consuming than the ISO 10273 method and reduces the number of biochemical tests required for the confirmation of Yersinia identification, through the use of YeCM.